Do All Clavicle Fractures in Children Need To Be Managed by Orthopedic Surgeons?

Paediatric clavicle fractures have traditionally been treated nonoperatively. Recent studies have recommended operative management for displaced midshaft fractures. We conducted a retrospective review of all clavicle fractures in children aged one to sixteen over a two-year period. We classified fractures and evaluated followup and clinical outcome. We identified 190 fractures. There were 135 boys and 55 girls. 65% of fractures were displaced and 35% undisplaced. Mean radiographic and clinical followup was 35 days and 44 days, respectively. Clavicle fractures in children heal with nonoperative management. Radiographs of clavicle fractures in children are unnecessary in the absence of clinical symptoms.

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Clavicle Fractures in Children

Orthopaedic Nursing ◽

10.1097/nor.0b013e3181b57a27 ◽

2009 ◽

Vol 28 (5) ◽

pp. 210-214 ◽

Cited By ~ 4

Author(s):

Elizabeth G. Shannon ◽

Erin S. Hart ◽

Brian E. Grottkau

Keyword(s):

Fractures In Children ◽

Clavicle Fractures

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Intermediate-Term Outcomes Following Operative and Nonoperative Management of Midshaft Clavicle Fractures in Children and Adolescents

JBJS Open Access ◽

10.2106/jbjs.oa.20.00036 ◽

2021 ◽

Vol 6 (1) ◽

pp. e20.00036-e20.00036

Author(s):

Ishaan Swarup ◽

Bhargavi Maheshwer ◽

Steven Orr ◽

Clare Kehoe ◽

Yi Zhang ◽

...

Keyword(s):

Children And Adolescents ◽

Nonoperative Management ◽

Fractures In Children ◽

Clavicle Fractures

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Flexible intramedullary nailing versus nonoperative treatment for paediatric displaced midshaft clavicle fractures

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.12.170185 ◽

2018 ◽

Vol 12 (2) ◽

pp. 104-110 ◽

Cited By ~ 3

Author(s):

I. A. Mukhtar ◽

K. M. Yaghmour ◽

A. F. Ahmed ◽

T. Ibrahim

Keyword(s):

Intramedullary Nailing ◽

Rating Scale ◽

Surgical Complication ◽

Skin Irritation ◽

Nonoperative Treatment ◽

Flexible Intramedullary Nailing ◽

Fractures In Children ◽

Clavicle Fractures ◽

Return To Activity

Purpose The treatment of displaced midshaft clavicle fractures in children remains controversial. The purpose of our study was to compare the outcome of displaced midshaft clavicle fractures in children who were managed operatively by flexible intramedullary nailing (FIN) with nonoperative treatment. Methods A prospective review of 31 children (mean age 10.5 years) with displaced midshaft clavicle fractures treated either by FIN or nonoperatively and with at least a six-month follow-up was undertaken. In all, 24 children underwent FIN and seven underwent nonoperative treatment. The patient outcomes included the Constant-Murley score, Customer Satisfaction Questionnaire (CSQ-8), numeric pain rating scale, time to union and time to return to activity. Surgical complications were recorded. Results The two groups were comparable with regards to age, gender and mechanism of injury. At six months of follow-up, the Constant-Murley (97.8 versus 94.7, p < 0.001) and CSQ-8 (29.1 versus 19.1, p < 0.001) scores were higher in the FIN group. Time to union and return to activity were significantly shorter in the FIN group (7.3 and 9.2 weeks versus 10.4 and 16.6 weeks respectively, p < 0.01). The only surgical complication was a FIN exchange for skin irritation due to nail prominence. Conclusion FIN is a minimally invasive procedure for children with displaced midshaft clavicle fractures associated with shorter time to union, quicker return to activity and higher Constant-Murley and CSQ-8 scores when compared with nonoperative treatment. However, the difference in Constant-Murley scores was not clinically significant. Furthermore, the advantages of FIN are at the expense of an increased complication rate of 12.5% (upper 95% confidence interval 33.3%). Level of Evidence Therapeutic, II

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Complex clavicle fractures in children: Kids are not little adults

Trauma ◽

10.1177/1460408617724815 ◽

2017 ◽

Vol 21 (1) ◽

pp. 35-39

Author(s):

Hayk Stepanyan ◽

William Hennrikus ◽

Derek Flynn ◽

David Gendelberg

Keyword(s):

Pediatric Patients ◽

Adult Population ◽

Clavicle Fracture ◽

The Body ◽

Bony Union ◽

Dash Score ◽

Non Union ◽

Fractures In Children ◽

Clavicle Fractures

Background The clavicle is the most commonly fractured bone in the body and accounts for 10–15% of all pediatric fractures. Adult patients with complete midshaft clavicle fractures often undergo surgical management. Pediatric patients have a thicker periosteum, more robust blood supply and a greater healing potential. Controversy exists as to whether to treat adolescents with surgery similar to adults versus with a sling as children are treated. Some orthopaedic surgeons are now operating on adolescent clavicle fractures. Objective The objective of the study was to evaluate the outcomes of displaced midshaft clavicle fractures in adolescent who were treated conservatively with a sling. Methods We performed a retrospective chart review of 25 pediatric patients aged 12–16 with complete midshaft clavicle fracture. The outcomes of the study were bony union and functional outcomes such as pain, problems with ADL measured by the modified Disability of Arm, Shoulder, and Hand (DASH) score. Results All patients in our cohort had excellent outcomes at follow-up visits with no complaints of pain or limitations of activities of daily living. Mean follow-up time was 12 months. All patients had perfect modified DASH score of 18. Injury radiographs demonstrated an average of 13 mm shortening initially and 8 mm shortening in final follow-up. Average fracture angulation at final follow-up was 15°. Normal clavicle angulation at the mid shaft is 8°. All clavicles healed completely with no case of malunion or non-union reported. Conclusion Clavicle fractures are common. Although operative treatment of clavicle fractures in the adult population is gaining popularity due to issues in adults with non-union and malunion, the adolescent population is different. The adolescent clavicle fracture demonstrates robust healing and remodeling and complete return to full function. We therefore recommend that adolescent patients aged 12–16 with complete clavicle fracture be treated conservatively with a sling.

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Wrist buckle fractures: a survey of current practice patterns and attitudes toward immobilization

CJEM ◽

10.1017/s1481803500008228 ◽

2003 ◽

Vol 5 (02) ◽

pp. 95-100 ◽

Cited By ~ 11

Author(s):

Amy Plint ◽

Tammy Clifford ◽

Jeff Perry ◽

Blake Bulloch ◽

Martin Pusic ◽

...

Keyword(s):

Management Strategy ◽

Current Practice ◽

Practice Patterns ◽

Pediatric Emergency ◽

Pediatric Emergency Department ◽

Optimal Management ◽

Wrist Fractures ◽

Orthopedic Surgeons ◽

Fractures In Children ◽

Pediatric Orthopedic

ABSTRACT Objectives: Buckle fractures are the most common wrist fractures in children, yet there is little literature regarding their management. This study examined the management of these fractures and attitudes toward their immobilization by pediatric emergency department (ED) physicians and pediatric orthopedic surgeons. Methods: A standardized survey was mailed to all pediatric orthopedic surgeons and pediatric ED physicians at 8 Canadian children’s hospitals. Results: Eighty-seven percent of physicians responded, including 33 of 39 pediatric orthopedic surgeons and 84 of 96 pediatric ED physicians. Sixty-four percent of respondents believe that wrist buckle fractures always need to be immobilized; pain control was most frequently cited for this belief. Physicians who did not believe that all buckle fractures need to be immobilized indicated that these fractures are inherently stable and have a low risk of refracture. Forty-eight percent of the orthopedic surgeons prefer below-elbow casts, 30% prefer a combination (splint and cast) and 12% prefer backslabs. Sixty percent of ED physicians “usually or always” use casts and 31% “usually or always” use backslabs. Although there was variation among the orthopedic surgeons regarding the recommended length of immobilization, most (70%) recommended 2 to 4 weeks, although some (12%) treated only until pain free. ED physicians showed greater diversity regarding length of immobilization. Conclusions: Although many physicians believe that wrist buckle fractures need to be immobilized, a significant number do not. There is substantial variability in the type and length of immobilization used. This variability suggests that the optimal management strategy for wrist buckle fractures is unclear and should be determined in future prospective studies.

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